Addressing the ICU’s many complexities, and why ‘one size doesn’t fit all’

Nutrition is a complicated concept with many factors: a healthy diet or lack thereof, and total caloric intake to name a few. When patients first enter an Intensive Care Unit (ICU), every little thing attached to health is that much more important – and nutrition is no exception.

In advance of the European Society of Intensive Care Medicine (ESICM) Congress in Milan, we spoke with Professor Pierre Singer, Director of the Intensive Care Unit at Rabin Medical Center in Tel Aviv and a leading expert on nutrition. Dr. Singer sees firsthand the challenges in the ICU, and the incredible importance of nutrition.

What are the main challenges you face on a daily basis in the Intensive Care Unit?

There are many obstacles we see in the ICU – particularly around nutrition, which has become increasingly complex because of a growing number of patient complications. There is nothing in the textbooks that gives us a ‘one size fits all’ approach for ICU patients. This is especially true for patients at severe risk of malnutrition and in need of constant support. Because of this, we need precise tools and measurements to support our decision-making. One of these tools is indirect calorimetry.

What is indirect calorimetry, and what role does it play here?

Indirect calorimetry is one of the only ways to measure and monitor a patient’s energy expenditure based on oxygen (O₂) consumption and carbon dioxide (CO₂) production. It requires very strict levels of stability – for example, there can be no chest drainage or leakage. That said, overall it’s an easy process to achieve, especially with the right equipment. For instance, GE Healthcare’s solution helps to assess a patient’s energy expenditure and monitor it continually. You can easily see the variation of requirements minute by minute, hour by hour, day by day. This constant monitoring of the patient’s energy level is absolutely critical.

Why is the patient’s nutrition so important?

Patients in the ICU undergo huge metabolic changes induced by stress, hormone release, anesthesia and other factors. The body tries to overcome this stress, which requires a lot of energy and often results in decreased muscle mass. This can subsequently increase the length of hospitalization, as it can take weeks or months for patients to be able to regain the strength to walk out of the ICU. In reality, the overall quality of life can be impaired because of these drastic changes in their metabolism.

What’s the future of the ICU, and how can we continue to improve patient care?

We have to deal with the complexity of the patient by assessing all of the problems they are facing. It’s not only the calories but also the amount of protein, carbohydrates and other factors. We are looking to find a way to integrate all these parameters in order to prescribe a more personalized way to care for these patients. It’s impossible to recommend one universal number of calories to all patients because patients are so different. We are going to see more and more personalized care in the ICU.

Last year, Nestlé Health Science and GE Healthcare teamed up to improve nutrition monitoring for patients in the ICU. This new solution uses data analytics to digitally connect specific patients with personalized plans: in other words, the nutrient-delivering equipment knows exactly what to provide for individual patients, and monitors continuously with this in mind.

The first clinical results of this integrated approach will be shared during the GE symposium at the ESICM congress on October 4, 2016.